=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891019154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS L DAVIS LCSW - BACS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2010
-----------------------------------------------------
Last Update Date | 03/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 JOHNSTON ST SUITE 300
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-201-7816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8778 HIGHWAY 1200
-----------------------------------------------------
City | BOYCE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71409-8776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-201-7816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 935
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------